Commitment Process: When a Person is a Danger to Self or Others

Updated on December 5, 2014

The Importance of Mental Health

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In the United States, approximately one in four adults suffers from a mental disorder (National Institute of Mental Health, 2004). These numbers may be greatly out of date. According to John Grohol, Psy.D., as many as 75 million people, or one in three adults, suffer from mental disorders. This figure includes diseases such as alcoholism and drug addiction.

As the number of mentally ill people grows, it is evident that in our society not everyone receives the necessary care. Treatment can range from outpatient clinic care, in which a patient meets a qualified therapist, or inpatient care in a psychiatric facility, state hospital, or special unit in a general hospital.

If a person seeks help in an outpatient clinic, a psychiatrist (a medical doctor specializing in mental disorders) will treat the patient with medication and evaluate its effectiveness. A therapist (psychologist, social worker, or nurse) will meet with the patient for a session in which cognitive therapy, group therapy, or other variations of therapy are used. The therapist will have expertise, and advanced education, in the specialty of psychological disorders and mental health.

These therapy modalities are used to support the client’s problem-solving ability and bring them to a higher level of functioning. A set number of sessions are usually initiated on the first meeting, often dictated by a client’s ability to pay or whether an insurance case manager has assigned a designated number of sessions.

However, what happens if a person cannot afford to see a clinician and their mental condition continues to deteriorate? When payment, through self-pay or insurance, disqualifies one for private sessions, how does one get the help or hospitalization they need?

Psychiatric Hospitalization

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When therapy is not enough to help a person with a mental health disorder, hospitalization may be the best process to protect all parties.

What is the process of hospitalizing someone with a mental illness? The broad terms of inpatient involuntary commitment is that the person is deemed to be a "danger to himself, a danger to others, or is incapable of taking care of his needs." If a person meets any of these criteria, he or she can be detained in a psychiatric hospital or mental health unit for observation and examination.

When a person is committed, it is usually because they do not recognize their need for treatment or do not agree that they need it. Although they may protest being hospitalized, they must follow the decision of a magistrate who has signed the legal affidavit which claims the terms of the hold. On this form, the date, time, number of days for the hold, and explanation of the person in question’s behavior is detailed. The affidavit will also state the name and address of the person who has requested the involuntary commitment.

Once the form is signed by the magistrate, it is brought to the police department who will send an officer to transport the person to the closest hospital emergency room for an initial medical exam. That documentation is considered to be the first mental health exam, and the physician’s findings, which include a psychiatric diagnosis, will be documented and accompany the person to the accepting psychiatric facility.

Upon admission, the psychiatrist has 24 hours to conduct a mental status exam on the patient to determine if this person indeed meets criteria to continue the commitment. This is referred to as the second exam and the findings are faxed to the judge at the county courthouse.

Other times a person may enter the hospital emergency department with a medical complaint and emergency room staff will alert a physician that a psychiatric evaluation is warranted. Criteria for that request include psychotic behavior or patient threats of suicide or homicide. In these cases. the patient may be given the choice to be transported to the unit as a voluntary patient, if the patient agrees to sign himself in for treatment, or to be transported as an involuntary patient. If the person refuses to sign him or herself in, and meets the requirements for commitment, the medical personnel is required by law to process an involuntary commitment form, especially in cases of suicidal or homicidal threats.

Mental Illness and the Law

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In the United States, mental health laws are designed to protect people from getting lost in the system, forgotten, or lose access to treatment. Nonetheless, these laws are still abused through loopholes and the process can be manipulated to suit certain parties.

Laws that were erected to protect the mentally ill are sometimes misused to hospitalize people whose behavior is eccentric. In some cases, family members may abuse the law to commit a relative so that the relative will lose control of disputed family property.

The Florida Mental Health Act of 1971 (also referred to as the Baker Act, after state Representative Maxine Baker, who advocated for the mentally ill) was created in response to numerous cases in which family members committed elderly relatives and took over their estates. This form of commitment in state mental facilities is identified as a form of elder abuse.

Any person, regardless of age, who has been detained through an involuntary commitment process has the right to a hearing before a judge within a set amount of time. Usually the hearing window is the first 10 days of admission. The patient has the right to be present and appeal the commitment individually or with counsel representation. If the person is unable to afford counsel, they have the right to court-appointed representation.

During the hearing, the judge will listen to testimony and review documentation presented by the psychiatrist, the first examiner, or other staff with evidence of the patient’s condition. The judge will then listen to the patient. Questions may be asked and the circumstances leading to the lock-up will be reviewed. If there is insufficient evidence that the criteria for commitment is met, the judge will release the patient. The judge may also extend the treatment by a certain number of days—usually ten to fourteen. A follow-up court date will be set to ensure that the patient is not stuck endlessly in a locked facility.

Mental health laws vary from state to state, but each state has an obligation to follow the process through the legal system. In 1975, the U.S. Supreme Court ruled in O’Connor v. Donaldson thatit is unlawful to hold a person against their will without a timely evaluation and that they must be released if there is no evidence to substantiate the need for continued hospitalization.

An Example of the Legal System at Work in an Involuntary Commitment Case

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As a psychiatric nurse, I’ve been present at commitment hearings on occasion. I have seen how hearings can protect patients from being held unfairly by people who do not have the best interest of the patient at heart. When I was a student nurse in 1983, I watched as several cases were presented in a Detroit courtroom. My instructor asked for our decisions on the cases prior to hearing which way the judges ruled.

One case stands out in my memory. An elderly African-American woman had been committed by her daughter. The older woman was skinny and animated. She looked disheveled in her crumpled clothes. A colorful knit hat on her head created a bizarre look that made one take pause. Going by appearances alone, it was an easy call.

The daughter alleged that her mother was exhibiting paranoia and was delusional because she locked herself in her house, barricaded the door, and threatened anyone who approached the house with a baseball bat. After listening to the facts, most of the students were convinced that she was committable.

However, as the judge questioned her, she had a logical and reasonable explanation for everything the daughter had said. She countered the allegations and insisted that her daughter was attempting to take guardianship of her finances. Regarding the eccentric hat: It was cold at night in her house and it kept her head warm. She locked and barricaded her doors because she lived in a bad neighborhood and was afraid at night. She explained that she kept the baseball bat as protection from “any fool who would come knocking on a door in the middle of the night."

The judge ruled her competent and dismissed the case.

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Comments 114 comments

Thank you for giving a voice to a segment of society that is largely ignored and swept under the rug..It is very sad that simple counselling is not available to the average American...like preventative medicine, it would go a long way to keep people from going all the way over. Great Hub. Thank you.

Denise Handlon 6 years ago from North Carolina Author

Hi Lilly-nice to see you here. Thanks for the comments. Yes, it is a sad situation, and a much neglected group.

Simple Tim 6 years ago

Great advice on a subject that is often misunderstood and therefore left untreated! More awareness on mental health is definitely needed.

Denise Handlon 6 years ago from North Carolina Author

Hello Simple Tim-thanks for stopping to read and comment. I've been working in the field of m.h. for over two decades and am amazed at how uneducated most people are about this subject. I suppose most people are afraid of what they don't understand and the erratic behavior of someone in a psychosis or delusional is baffling. Thanks for your time.

Chizenista 6 years ago

wow rather eye opening. I have an uncle that gets social security benefits but he walks the streets, dumpster dives, and picks up random cigarette butts. He is schizophrenic. One time when I was working at a retail store and me and my manager were making the a.m. deposit at our local bank i seen him at the bank out door ashtray. My manager advised me not to get out of the car that he might rob us lol. i said no thats my uncle he's harmless. He hasn't been locked up yet im surprised. He must have slipped through the cracks.

Denise Handlon 6 years ago from North Carolina Author

Hi Chizenista, thanks for reading the hub and commenting. Takes courage to admit that a family member is mentally ill. My heart goes out to your uncle. Most schizophrenic street people are not harmless, they're just trying to get by. He would not be picked up unless he had been causing a problem. The criteria-'cannot care for self' would fit if a family member went through the steps to I.V.C. him-that is, by going to the magistrate and filing a form to commit him b/c he cannot care for himself, isn't taking meds, hallucinating, etc. Then he would be picked up and taken in for an evaluation. They may or may not keep him, however, it sounds like he would qualify for a person in need of treatment. But, each state is slightly different and w/o the proper legal paper work we can't just go around and pick people off the streets. (Well, actually back in the 80's a couple of the larger psychiatric organizations tried to do exactly that, but that's another story. Thanks again for your input.

John B Badd 6 years ago from Saint Louis, MO

I think the number of people who are mentally ill is a reflection of a sickness in our entire society. I think our self deluded views of the world coupled with our entitlement mentality and self pity make us ripe targets for self victimization. Next thing you know the government will be spending my tax dollars to coddle and medicate 75million (one quarter of the US population) self loathers.

There is a small portion of the world that truly needs psychiatric help and some even need medication. Most just need to suck it up and accept that the world does not owe them and no one said it was going to be an easy ride.

Denise Handlon 6 years ago from North Carolina Author

Boy have you said a mouthful, John. Take it from one who sees it frequently. Wouldn't it be lovely if all of us could enjoy the luxury of being taken care of--or not. I think it is actually a very immature way of living. It is amazing to me how many people are caught up in addictive behavior that also perpetuates this sickness in our society. Thanks for stopping in to read the hub.

fetty 6 years ago from South Jersey

A great deal of timely and useful information about mental illness. My family has a "garden variety" of mental illness issues. Interestingly, my schizophrenic sister has produced three college educated contributing members of society. Only one son has dared to have a child, though. There is so much we do not know about this disease! I am very proud of my nieces and nephew.

You have written a beautiful piece . Thank you!

Denise Handlon 6 years ago from North Carolina Author

Hi Fetty, Thanks for reading and commenting. I tip my hat to you for sharing your info...I can certainly relate.

The mentally ill are too often disregarded in our society. Compassion and understanding go a long way. :)

kaltopsyd 6 years ago from Trinidad originally, but now in the USA

This is a great Hub on this subject. You covered everything so well. Isn't it interesting that as research and knowledge increases, so does the mental illness prevalence?

Denise Handlon 6 years ago from North Carolina Author

Hi Kim, nice to hear from you. You would know about this subject, so I appreciate the feedback. Now, about the correlation between research/knowledge increasing and the increase in M.I.--Not sure I am following you, nor have I made that correlation. I am hypothesizing that the increase in M.I. is related to the increase of addictive behavior in our society, and the lack of spirituality. As the egoic structures deteriorate from the primitive compulsions, the separation from the true nature of being is more acute. This leads to more acting out because of the painful suffering of being separated from our true identity, but being unconscious and unaware of that soul center. That is my theory, anyway, for all it's worth. Nice 'discussing' life with you. :)

kaltopsyd 6 years ago from Trinidad originally, but now in the USA

Haha, that makes sense. However, I'm not saying the they're RELATED (correlation doesn't equal causation) but it's ironic. Greater research and knowledge is supposed to be LOWERING MI cases but it really isn't. That's what I mean. Does that make sense?

Denise Handlon 6 years ago from North Carolina Author

Sadly, perfect sense. I agree. What is up with that? It's really quite sad.

kaltopsyd 6 years ago from Trinidad originally, but now in the USA

It sure is sad!

donotfear 6 years ago from The Boondocks

I wish it was easy to go through the process. But when you live in an area with NO inpatient facility, it's hard. What happens to us here in extreme NE Texas is that we have to E.D.(emergency detention order) the client to the local E.R. If deemed acceptable for hospitalization, and if they do not have insurance coverage, the client is then put on a wait list for the nearest state hospital. The ER is then faced with the burden of caring for them for sometimes days while they wait for a bed at the state hospital. Sometimes, the clients are very severly ill....an E.R. is no place for them! But we have no o ther choice. What else can we do if they are so psychotic they think they are the president, or smearing feces on the walls? We have one nearby county who will hold them in the detox cell at the jail until they get a bed. It's horrendous. But we have no funds to build a Crisis Holding Center, which is what we need. Very trajic, I wish the laws protected the people here, but I know of none.

Lady Guinevere 6 years ago from West Virginia

Wow I came her to see if you plagarized my article on the Involuntary Commitment Process. I see you have mine linked in here but you haven't plagarized my hard work on mine. That being said thank for telling if from another point of view. This stuff needs to get out because my husband is a Crisis Team Member for the local Mental Health Center and has calls where people really have no clue as to what is going to be happening and what the steps they need to take are.

Denise Handlon 6 years ago from North Carolina Author

Donotfear & Lady G-thanks for stopping by to read this hubmob hub. As you can tell by my profile, I'm still relatively new here at Hubpages. I wrote about the commitment process after making a decision to participate in the hubmob question. It was the first hubmob challenge I did and well, you know what they say: write what you know. It was the first thing that came to my mind.

As a psychiatric nurse of 25 years I am very familiar with the process in the states where I have lived. However, I was unaware, DNFear, about the conditions in TX. I'm so sorry to learn that. That is a tough situation.

Lady G-I first read your piece about Totems (4 months ago shortly after I joined HP) and left a comment for you, which you responded to. Likewise for the Commitment piece you wrote. Let me assure you...or 'reassure' I do not plagairize. My writing stands on its own merit.

I write from the heart and the head and do my own legitimate research as needed. I'm sorry if you have had that experience from other people. But, with the plethora of subject matter 'out here' there is always something to write about and a new angle to use when the subject has seemingly been exhausted.

Plagairizm is cheap. I consider my writing to be far above stooping to that. If there is an overlap of subject matter it is mere coincidence. I'm glad you discovered this about my hub through your own investigation.

Lady Guinevere 6 years ago from West Virginia

Well I really liked your angle on it. I had done mine with my husband behind me all the way. He does this for the Mental Health Center in our area. Before I published it he went over it with a fine toothed comb so that I did not give any misguided representations. I wrote it because when he does get calls people really don't know what to expect and so I was shedding light onto that area.

Yes one of my other hubs was flagged as duplicate, but I didn't get anything of it from the internet and I haven't posted it anywhere else but here. It was a personal experience I had a few days ago. So I sent the URL to hubpage management and they will get back to me tomorrow after noon I hope.

Denise Handlon 6 years ago from North Carolina Author

Hi Lady G-I'm sorry to hear that you are having problems with duplications. I can understand your concern. No one wants to have their hard work copied. I wish you the best in your resolve of this problem. Thanks for your comments.

kimh039 6 years ago

Very informative, Denise. I may have to come back for a re-read. I'm encountering a lot of situations lately in my work that involve forced meds as well - where a pt refuses meds but can be forced to take them if it's in their best interest.

Denise Handlon 6 years ago from North Carolina Author

Hi Kim, glad you are finding the hub useful. Let me know how it works out for you, re: patients & meds.

Dale 5 years ago

I have floundered with depression, and continue to take meds to prevent relapse. The affluent have resources, often insurance, perhaps dicretionary funds, that allow them to get help. The indigent, and the VERY ill, often have access to subsidized or free mental health care. However, many people, working people, live on the margins of economic viability. They may not have mental health insurance (many people have NO insurance), or a large deductible, that would force them to choose BETWEEN groceries, shoes for their children, or mental health. A licensed therapist can cost $100 - $200 dollars per session, and months, even years of therapy is not unusual. So,many people face years, even a life time of slugging through depression and/or anxiety, living internally gloomy, angry, unfulfilled, diminished lives because they can't afford to be mentally healthy. And, they're not sick enough or poor enough to "qualify" for assistance, YET.

What price does society pay for diminished productivity, criminal behavior, broken families, and broken spirits? Might not it be in EVERYBODY'S best interest to make mental health care affordable and accessible to all? Even if ignoring the argument that we might CHOOSE to create a compassionate culture that provided the means for people to find happiness

Dale 5 years ago

John Badd:

I think people with diabetes should simply "suck it up" and accept their reality of gangrenous limbs and early, painful death. It's probably their own fault, anyway. Pussies. Wimps.

Denise Handlon 5 years ago from North Carolina Author

Dale-I understand your frustration. I deal with that with my nephew. I often wonder what will happen when he is no longer under my care. It is a frightening realization. Unfortunately, mental health is the ugly step child of health care coverage. In the late 80's and 90's the 'reform' began with insurance companies refusing to pay for extended care services. Then came the closings: the state facilities and community mental health clinics. Why? Because there was no money in it.

That is when we really began to see more mentally ill homeless on the streets. Where would they go when they decompensated? As for the 'average' American...absolutely true-prioritizing between an antidepressant and groceries or utilities/house payment, is a no brainer. Something has to give so people stop taking their meds b/c they cannot afford them. And, the cycle continues...the depression returns or deepens and the quality of life decreases.

I have had a long standing affinity toward those afflicted with a mental illness condition. Perhaps, because I too have battled depression. Or, perhaps because of the chaos and dysfunction I grew up with in my home. It evokes a compassion in me to see someone who struggles with functioning on a daily basis while battling the demons within.

Thanks for sharing your thoughts. My heart goes out to you. Take care.

kimh039 5 years ago

I came back for that re-read Denise. Very informative from the legal perspective. Thanks again.

Denise Handlon 5 years ago from North Carolina Author

Hi Kim-how are you? HOw is the work situation for you? Let me know if you want to chat off this site. Shoot me an email. Thanks for stopping by again.

Arlene V. Poma 5 years ago

Denise, I sure wouldn't want your job. I spent years being around mentally ill inmates in a pilot program that is now the norm for California prisons. I didn't (and still don't) care for the shuffle. When it comes to mental illness, it makes such a big difference when you have supportive friends and family to help with the healing process. Unfortunately, these people in our prisons will not heal. They are simply lost in the prison system. Say, if they ever returned to society, they will fail and go back to prison. It's such a losing game for everyone involved. I appreciate your POV.

Happyboomernurse 5 years ago from South Carolina

Very comprehensive and well documented article about the commitment process when someone is a danger to themselves or others. Thanks for sharing this important information. Voted up, useful and interesting.

Vicki99 5 years ago from Meridian Idaho

Very useful information. More often than not, loved ones of individuals with mental health issues are hesitant to have them committed. Your case studies listed at the end should ease those fears a little.

Denise Handlon 5 years ago from North Carolina Author

Arlene-it is difficult at times and frankly, I've been doing it for so long I am ready for a change. I think it would be different if I had a reprieve somewhere, but I am raising my nephew who suffers from chronic issues himself and there is no 'break' from the draining toxicity. I feel for those caught in the penal system...it is a sad situation and a dangerous one.

Hi Gail-thanks for your comments and vote.

Vicki-you have no idea how hesitant family members are b/c it changes the relationship between them once it happens. Thanks for reading.

Melovy 5 years ago from UK

It’s very interesting to read about this as the process is clearly different to how it is in the UK. I have a sister who was forcibly hospitalised many years ago and it was a very traumatic experience for both her and the rest of our family. Was it necessary? Did it help? She always maintained the answer to both those questions was no, but she did come out of psychosis in hospital, so I can’t honestly say. She has been in the grip of paranoia again for a long time and the general process seems to have changed. The mental health professionals don’t see hospital as the solution this time, but so far they have not been able to help my sister. It’s very sad really, to see someone you love suffer in this way, yet I can also see that it comes about because people just didn’t know how to relate to each other. The positive side of my sister’s situation is that the rest of the family have become more open with each other, and my parents in the eighties are continuously adapting and growing in wisdom.

Thank you for this hub highlighting this process.

Denise Handlon 5 years ago from North Carolina Author

Hi Melovy-I am sorry to hear that your sister suffers from paranoia. My youngest brother also suffers from paranoia and delusions, although he is semi functional and has never been hospitalized. It is his son, my nephew, whom I am actually raising right now...so, I am always mindful of family genetics and try to keep him on track with reality. I already sense a strong propensity for him to distort the reality of what has been said, or what he sees. It is very frightening to observe the fragility of another's mind.

On the other hand, I am thoroughly intrigued that there is no universal process and the UK has a different process of commitment than the US. I would love for you to email me the info if you are inclined to do so.

Thanks for reading and sharing your experience.

Melovy 5 years ago from UK

Denise, I’ve sent you an email. Can you let me know if you receive it as the 2 times I’ve emailed someone before I got no reply so don’t know if there’s a glitch and my emails maybe don’t get through.

Denise Handlon 5 years ago from North Carolina Author

No problem, :) I did receive it and thank you very much for responding to my question. I sent one back to you which you should have received by now. Thanks.

jasper420 4 years ago

Very informive hub I have been committed more than once for my mental illness its not an easy thing to go through im glad you choose to write about this I learned alot of info I didn't know before

Denise Handlon 4 years ago from North Carolina Author

Jasper420-it is a very emotional time during a commitment process-I wish you well in your ability to maintain your mental health. I'm glad to know that this hub has been helpful to you and that you've been able to learn something new that you've not known before. Thanks for reading and leaving a comment.

megni 4 years ago

Excellent information.

Denise Handlon 4 years ago from North Carolina Author

Thank you for reading and commenting megni. Glad it was useful.

Rose43 4 years ago

Good morning,

I have a question about my sister who is mentally challenged. She is 58 years old and lives in a different state GA. She is living in a run down motor home with no water and septic. I have been trying to find someone to help me with her to see if there is anything or anyone that can help. I have ran into so many road blocks that I just son't know where to turn.

She is currently in a hospital in GA with a blood clot on her heart. This is the 3rd time she has been admitted to the hospital for blood clots.. the 1st on almost killed her.. I am very concerned with my sister's help and I have no where to turn.. Can you give me some advice to see where I may go to see where I can possibly get guardianship over her to where she can come home so my mom and I can take care of her?? I don't know where else to turn..

I appreciate any advice you my give.. God Bless

Rose

Sara 4 years ago

Do I have the right as a family member to not let them take my brother in to a mental institute even if a doctor potations it

Denise Handlon 4 years ago from North Carolina Author

Technically, No, Sara. Even if you were your brother's legal guardian, once a person is served involuntary commitment papers that are SIGNED by a judge or magistrate it becomes a LEGAL document and will have to go through the court system. He will be evaluated for a number of days. He can protest medications given to him (refuse) if that is what he wants. Then the doc can petition once more for a 'forced med order' and he would be injected with the medications he refuses to take. Hope that helps. Be sure to write to me again if you have any further questions.

hmschlmomma 4 years ago

Hi Denise - I'm not sure how much help you can offer, but I have an extreme situation here and I'm really grasping at straws and any advice will be much appreciated. Without really knowing if you can or will comment back, I will stick to very general short statements to explain the situation and then expound upon it if necessary. I live in Texas, my dad - who is an alcoholic and 72 years old lives in GA, all of our other family lives in either PA or Michigan. Right now my dad is sitting (according to his housekeeper) in a Quality Inn in his wheelchair, drinking and going to the bathroom where he sits. He has been there for 4 days. He will not answer the phone. He has a long history of alcohol abuse. He lives in a very nice $500,000 home with a wife of 10 years who has medical and pill addiction problems. She supposedly got a restraining order against him so he cannot go home (her name is not on the house). My dad has gotten 7 DUI's over the last 6+ years and served a 6 mth sentence in Whitfield County jail before being released on probation. My dad has not made his prob. weekly required meetings and although the police have been notified of such, they make it clear that they do not WANT to arrest him because he is too much trouble and they would rather he just drink himself to death. I certainly don't expect outsiders to have any emotional attachments to him and his self-inflicted problems - agreed! My question is - how does one go about getting someone in authority to require him to do something since 1) he is most definitely a danger to himself, 2) a doctor (don't said he cannot live alone, and 3) he is in imminent danger of death if nobody does anything. I understand the process ONCE a judge signs an order. My problem is how to go about getting that order? Even if it means I must fly over there. Yes, there is a lot of family history and very few wish to help and more importantly he is not going to willingly accept help - he has been to several rehabs - none long enough and he always starts drinking again. He has the money to pay for any "solution" however money isn't going to fix this one I fear. If there is any good starting point you can suggest, I would be very grateful. Sincere thanks, Robin

sher 4 years ago

This is an interesting article. Unfortunately i have seen the other side. It is a sad realization that mentally ill people have more rights than those without a mental illness. My family has suffered at the hands of this. We have a relative who is bipolar (she told us). However she does not take her meds and is an alcoholic as well as popping pills (what kind? ...any kind she can get ahold of). As you well know that makes for a more troublesome and evil problem. She has been in trouble witht the law since the age of 17. Her record is DUI's, leaving the scene of an accident, false reporting, battery and assalt, burglary and other smaller criminal offenses. She is now 33. We lived close to her before we knew of the problem. We soon found out. In that time she reported my family to Family services...it was a false report...she called on all the neighbors. The law protected her and even though the state knew she was reporting all of usand on false terms nothing was done. My neighbors and myself tried to tell the authorities and explain even enlisting the help of her criminal background. We were ignored and yelled at because we told them as well that she was bipolar and not taking meds. The problems continued with her and her fiance'. She started doing strange things like knocking on our doors at odd hours and lurking around in the shadows watching us. None of us could even bring the garbage out without somehow being watched or approached. We all kept our distance because it was easier that way and she lied continually so it became an issue with not speaking to her because in speaking to her she would go to another neighbor trying to start gossip and dissension among neighbors. Wea all peacefully told her seperately that we just needed to live our separate lives and not be involved. This did not suit her because she could not wreak havoc between us all...drama...which is what she seemed to thrive on. The authorities were called often during her outbursts and wreaking havoc....however the police never wanted to do anything because legally she was just within the bounds of being lawful. She knew this of course....HOW??? well she has lived in and out the justice system and had learned throughout the many years what was lawful and what wasn't. She moved out for a short time...and stayed with her dad and step-mom....in that time she called the authorities on her dad and mom (elderly people)....stating that they had battered her....this was a false report....and her dad had her trespassed off the property. SAD!! Eventually she pushed and pushed and pushed (everyday) that my husband yelled at her to leave us alone. She called the police and said my husband burglarized and battered her and her fiance'. She staged the incident and my husband was arrested and incarcerated. My husband did not do this....i know i was there. He yelled at her but she knew exactly what to do and how to stage and what to say to get it done. Because of her false report we have suffered greatly....we are out thousands of dollars....my children have suffered...my husband took a plea as to avoid jail time because of our children. He lied about being guilty to avoid jail. If an officer would believe a false report what would a courtroom do??? When we spoke to the officers over the course of time we were told there was nothing we could do and that we had no right to tell them about her mental illness because of HIPA laws. Since that time her and her fiance' have been trespassed from another property...this time a business...and most recently her fiance' has been arrested for false reporting....and i KNOW that her hand was in it. She has a 1 year old daughter and i cant even tell you what that baby has gone thru....nothing that leaves bodily marks but neglected and psychological abuse for sure. In my stste of Florida NOBODY wants to see the problem and it keeps getting swept under the rug. Like i said originally we seem to have less rights than the mentally ill.

Carolyn Marie 4 years ago

I am very concerned for both of my brothers - My father passed away last year and is no longer around to "take care of them" - both are addicts - one drugs and one alcohol - neither have ever been able to take care of themselves. We have tried to get them into different programs -- the alcoholic brother has spent months in different programs - but whenever he gets out - he ends up back in the same place. He is living in a RV using a generator for power - The RV won't run and is falling apart - I am afraid someone will come up on him when he is passed out and kill him. He is not physically able to work - to this point we have been able to give him funds from my father's estate - but that is running out - he isn't mentally or physically able to take care of himself. He is 50+ years old -- what would you suggest. He is in Alabama --

Denise Handlon 4 years ago from North Carolina Author

Hi Carolyn-this sounds like a sad and familiar story. Since I work in a psychiatric hospital I hear it quite often-different details of course. I'm sorry to learn of your father's death, and I am sure you are very concerned with your ill brothers. They are both obviously ill bc of what you have written re: their history.

If you have read this 'commitment' article it is evident that is one solution, but as you have already experienced, a temporary one. Unless someone really wants to change their life, the old habits take over once again unless they are living with a caregiver.

Perhaps you can deem each of your brothers as incompetent and unable to maintain their own health and well being. They may need to be assigned a case manager to handle their affairs and to live in a residential or group home. It is sometimes the best alternative to wondering and worrying yourself to death. I wish you well and be sure to stop in again to let me know how this works out for you. Many blessings...

Denise Handlon 4 years ago from North Carolina Author

To Rose43--my apologies for not responding sooner...your comment was showing as spam...I sent you an email and hope you receive it. I'll be waiting to hear back from you. God bless...

Denise Handlon 4 years ago from North Carolina Author

Hi Robin...again, I apologize for not responding sooner to your questions and concerns re: your father. By this time you have no doubt found a solution. I hope all is well. I will send you a message via your email contact and hope to hear an update from you. Take care, God bless...

Denise Handlon 4 years ago from North Carolina Author

Robin...I hope to get a response from you with an update. :) Take care.

Denise Handlon 4 years ago from North Carolina Author

Sher, I'm so sorry to read that you have had to endure this horrible situation. It is very unfortunate when there is a family member who suffers from mental illness...it creates tension, wrecks havoc, and increases the stress level of all who are involved.

I know from first hand experience, I have a brother whom I had to estrange myself from. Now, my nephew, his son, has similar problems and I have attempted to raise him these past three years. I wrote another hub: Mental Illness: Trouble within the Family that describes my experience and you may be interested in reading.

What I have done, and what I advise you and your family to do, is to distance yourself from this person in all ways. It may seem cold, but you have to protect yourself. On a good day these types of emotional vampires cannot be trusted. They are reliable in one way only: in creating drama and stress. Second, get a restraining order on all levels based on the fact that this person has threatened you and you fear for your life. (It is your word against hers and your mental health is being threatened and your emotional stability and peace of mind is at stake). If she breaks the restraining order call the cops...continue to do this until she gets the picture. Do NOT let your guard down and teach your family members of all ages she is NOT invited into your home; get a phone with caller ID and a message center and instruct others NOT to pick it up w/o checking who it is. If a call gets by the message center and into your ear say goodbye and alert the authorities. Keep any MESSAGE she has on your recorder to play for the police when she breaks the restraining order. You must treat her like a criminal b/c she is robbing you of your sanity and peace of mind, not to mention all other areas. Hope to hear from you again...

concerned sister 4 years ago

My younger brother, in his 50's, appears to go from 1 to 20 RAGE and he turns on a dime. He just threathened to kill a family member in 5 weeks. Horrible and very odd statement. (He's working on a project-so maybe that's it??) We know he needs help!! What is he dealing with?? It's like he's a RAGE maniac. This is one of dozens of times he's been just off the wall raging at a family member or someone in public or traffic. It's so horrible. We have talked about in-house commitment to get him help but we are afraid to do a commitment for what his reaction will be after he gets out. We believe him to be a loving family member and then he just goes OFF! He might hurt someone and then regret it the rest of his life but that wouldn't take away the possible fatal action he might do. He seems to have had an odd change in his behavior and even his eyes and affect over the last 10 years+.

Denise Handlon 4 years ago from North Carolina Author

Dear concerned sister-what a dilemma...getting help for your brother and risking his rage and emotional/physical attack after hospitalization vs. ignoring his need for medical treatment and watching this illness progressively get worse until one or more people become victims of his madness.

When you are observing behavior that is getting worse, you understand that you are not dealing with an issue that is controllable-in other words, this is NOT a rationally minded person that you would be able to reason with and encourage to do the right thing without intervention.

If he were rational you could suggest he have a medical evaluation to get things started. But, that is not the case here. So, you or another rationally minded person, must make the decision for him.

I know that we are NOT talking about a situation in which someone doesn't like something that someone else has done or said and is angry or frustrated. What I understand from your explanation, is that he is trigger happy with unreasonable and irrational rage-a true DANGER to society when he threatens to do harm to other people. That does fit the criteria of getting him committed for treatment.

Does he have a family doctor? Does this family doctor also treat you? If so, make an appointment to discuss this with the doc and explain the concern you have asking for support in getting him treatment. Then, if you can persuade your brother to have a physical the dr can discuss this with him...and refer him to the local psych hospital for further evaluation. The psych hospital will take it from there based on the doc's referral.

If this is not the case, then go to the magistrate or courthouse to inquire on the procedure for filling out commitment papers and explain to them your concerns. The more detailed examples you have the better, including dates.

I completely understand your reluctance to get involved based on his threats to go after you or other family members, but he needs help and you are STILL at risk if he does not get this help.

The other REALLY IMPORTANT question you must find out is: does he have access to weapons? Anyone can walk into a store and buy a knife, and now it appears just as easy to get a gun. How 'potentially' dangerous he is at this moment is another important factor to bring to the attention of those who can help.

If you cannot get any answers to your situation that is resolved in his getting the help via an inpatient hospitalization, then call your local psychiatric hospital and ask to discuss this with the intake counselor. Ask for information on what it will take to get your brother an involuntary commitment and what you need to do to proceed with that.

This is important for you to know: There is a LAW that states you and those he threatens to harm when he gets out of the hospital, are notified of his release if he is still making threats and they cannot hold him, (which is unlikely, but occasionally happens). The facility MUST, as mandated by law, notify you to give warning that he is out. In that case, if he is still threatening, you can take legal action to restrain him from coming near you and your family. I do understand that NO paper can keep someone away from physically harming someone else if that is their intention. They would rather go to jail than to not follow through with their rage towards another. I'm sorry that I can't be more reassuring about this part of it-it does take much courage and risk to do the right thing at times-courage to care enough to get the other person help that they are blind to seeing themselves; and risking your own comfort and safety.

In the end, I like to believe, perhaps ideally, that those who care enough to do the right thing have a special protection that surrounds them and that all ends well. I know that can be a naïve way of belief, but it has helped me on more than one occasion to maintain my integrity and move forward in the direction of truth.

The truth, as you have explained to me here, is that your brother has a mental or emotional problem that is out of control and affecting his and your life adversely. Best wishes to you, God bless and I do hope that you return to this site to let me know how things ended up for you.

hmschlmomma 4 years ago

Update: First of all, thank you Denise for all your email correspondence over the last few weeks. My 72 year old father, who was in the motel in GA drinking in a wheelchair, was finally arrested and brought before a judge. The arrest stemmed from charges of assault by his wife. Based on the probation violation and the assault chgs he was told he had two choices: 1) go to alcohol classes(?) and violence classes, be tested daily for alcohol, see a PO weekly and get his life straightened out OR 2) violate any of the above and go to prison for 2 years. It has now been 9 days since he walked out of the courtroom. There is still an injunction keeping him from going to his own house (not sure why since wife is in assisted living center again) and he talking to people at Providence Ministries about joining their 6 month program. Since we are all long distance and the ONLY one he is talking to is his brother in Mich., we are limited to updates based on those phone conversations. My uncle is a very sweet, Christian man, but not necessarily a "worldly" man and I don't know that most of us can be as optimistic as he is. That being said - until something concrete happens (either drinks and gets caught or enters the PM prgm and sticks it out) we will pray to Almighty God for his deliverance. It can't remain in limbo for long and I am still among a few that believe the 40+ years of alcohol abuse has altered his thinking and brain ability and that he could still benefit from psych treatment. Only time will tell. Thank you again for your help Denise. I am glad to know there is someone who is willing to talk to those of us who feel lost in the process, not to mention the gamut of emotions one goes through. May God bless you and yours. Robin in Texas

Denise Handlon 4 years ago from North Carolina Author

Hi Robin-thanks so much for coming back and giving me an update. I've been thinking of you and your situation. So, his 'judgement' was his next step and, as you have stated, it will be a wait and see process. Forty years of drinking without any intervention is habitual, of course. So, my 'guess' is that he will break probation and drink. He has to...it is what the body knows, craves and needs.

In fact, for him to abstain without any intervention may create a physical withdrawal of dt's where the body goes into convulsions. The other symptoms of DT's are elevated blood pressure, tremors, racing pulse, sweats, increased respirations, feelings of anxiety and panic. I sure hope he gets into that program so someone can observe any physical and mental changes in his behavior. Usually the antidote is an antianxiety medication of Librium or Ativan during the withdrawal period. The DT's usually do not show up immediately. They can begin to show its face in 3-5 days.

And, speaking of changes, you are absolutely right in your assessment and assumption that his thinking and brain have been altered. Along with the liver damage, he may have suffered from oranicity or dementia. He may also be malnurished, because the alcohol depletes the body of important vitamins and minerals.

I'm glad that you are at peace with this latest development and that I was able to offer some answers for your questions. The only other thing to do, besides compassionately hold him in your heart and send prayers out for his well being, is to wait until the next piece of his life falls your way as far as news. Stay in touch with your uncle, of course, and hopefully it will turn out well.

Thanks again for the update, I appreciate hearing from you.

gsidley 4 years ago from Lancashire, England

I've stumbled upon your hub somewhat late. I found it very informative about the commitment process in the USA (I live and work in the UK).

After working in mental health services for over 30 years and (as my hubs show) I've grown increasingly dismayed with the way that western psychiatric systems operate. I think the example you give at the end of your hub (the eccentric woman with the baseball bat) neatly illustrates psychiatrists' obsession with labeling vast numbers of people as being "mentally ill" without bothering to find out the details of an individual's personal circumstances. Also, the as many as "1 in 3 Americans" having mental "diseases" prevalence estimates (espoused by NIMH, APA etc) are, quite frankly, ludicrous and is a blatant example of western psychiatry's propensity to medicalise any human behavior that deviates from the norm and then treat the assumed biochemical abnormality with chemicals. (vested interests here, no doubt). As far as mental health legislation is concerned, I believe it to be fundamentally discriminatory against people who happen to deviate from the norm. (I could go on, but I'll stop here).

Although I suspect our views about mental health may rarely correspond, I am interested in your perspective and enjoyed your well-written hub. So I have become your latest follower and look forward to some lively debates in the future!

Best wishes.

Denise Handlon 4 years ago from North Carolina Author

Gary-it is very nice to meet a fellow advocate in the mental health field. I'm glad to know that you found this article beneficial in its information about the U.S. commitment process. Like you, I've been quite disillusioned with the field of mental health in more ways than one. I find that the 'treatment' often perpetuates a dependency on the therapist or doctor. That is one area...another is the horrible expense of medication that is often out of reach for those who are mentally ill. The insurance companies are out of control with their pricing. There are other areas as well.

I'm not sure what the solution will be for the future. I feel that mental health care has been the 'ugly step sister' in the health care field and does not get the proper advocacy that it needs.

I do agree with you that the figures of Americans with mental diseases or disorders is very high. And, yes-it's not a far stretch to see the connection between the pharmaceutical companies and the doctors who are quick to place a patient on medication without trying non chemical modalities first.

Thanks for the following and your astute comments about the field of mental health. I'll be looking forward to additional discussions with you. :)

ArtistMike 4 years ago

I have a common dilemma, I have a friend who I am helping with their schizophrenic son. They just got guardianship here in Georgia. Unfortunately we have been told by the judge that there is no way someone can be forced in an institution unless they are a threat to themselves or others. Even though we including the Lawyer who was hired for her son said He has a collection of knives that because of his anger issues when visiting him that she had to have 3 sheriff deputies watch over him so that he does not go for one of them during the forced evaluation. Please forgive the long sentences I am trying to shorten the story. He has refused to see any doctors for a long time now. He recently took it once because I encouraged him to do it but he nor anyone else knew of his dosage because of the HIP laws, he overdosed because of his incapacity to know anything at all. He went into the hospital ER who sent him to a center for a couple of days, he has no insurance. He is home now and I am trying to get Medicaid for him since the first time his sister tried they actually denied him. His is 23 yrs old. I am also trying to find a group home that would help him take his medicine. I need a doc that will help us out and take medicaid.

His mother who he lives with is beside herself. He controls everything incl. her in the home. He has refused to take his medicine and has a habit of pulling his mom firmly (he is 250 lbs and around 6 ft tall). He has firmly grabbed my hands and tried to force me to do what he wants numerous times. I sometimes give in because I am a little afraid of his reaction. Don't get me wrong I mean grabbing something out of my hands or stopping me from holding the steering wheel etc. I do not see an out here. He lives in Marietta ga and I haven't found any place for him to live or anywhere we can find for him that would help him take care of himself. He never bathes He saves his urine in bottles etc. Is there any help you can give? He has been hospitalized a couple of times as well as the police have been called a couple of times.

Denise Handlon 4 years ago from North Carolina Author

Dear Mike-your comment/dilemma saddens me because it is all too common. It really doesn't matter that he is in GA...he could be anywhere and the situation is similar to many I have come across.

I'm not living in GA , so I don't know the specifics to the county information. HOWEVER: a person who is a threat to himself or OTHERS (his mother...) and cannot function well on his own or is living in conditions that are such as you've stated here: urinating in bottles in the home...is committable.

The process of commitment is simple: Mom has to go into the magistrates's office and sign a commitment paper describing what is happening. She needs to be explicit: threatening to harm me when directed to do things in the house; physically threatening me by grabbing me and when I tell him to stop he does not listen; Urinating in bottles in my house; Refusing to bathe when directed, then becomes angry and threatening; Refusing to take medication as directed, then becomes angry and threatening; has a knife collection in my home he refuses to get rid of and I fear for my life.

The word: 'threatening' has to be in the paperwork. When questioned, if mom is asked, "do you fear for your life" she CANNOT hesitate and say, "well...sometimes I worry..." She has to say "YES! Absolutely!"

Once the papers are filed she can go home...the officers will be given the paperwork and will pick up her son no matter where he may be at the time and take him to the nearest emergency room. Once there, he will be evaluated. Once deemed a danger to others and hospitalized the social workers and team will work on a discharge plan. Part of the discharge will be the question: Can he return home.

Again, Mom, if she does not want him living with her (and it doesn't sound like this is a wise decision), she has to be firm and say, "NO!" he cannot return. HOWEVER, there may be a glitch because she is his guardian. Which brings up the question: he is 23 and why and how did she assume guardianship? Was it to take control of his money...is he on social security or disability? If Yes, then she may have to take him back. BUT, cross that bridge later. Right now...get him into a hospital!

If you have some time you can read through some of the other situations posted here. Good luck with this and please return if you would, and let me know the outcome. Thanks and best wishes to you.

Daryan 4 years ago

Ihave a family member living in california who is a complete danger to himself and everybody around him...we have tried to have him committed to no avail, even after he was diagnosed with skitsophrenia. My entire family is at their wits end and nobody feels safe. What should we do? Please help us! Thank you....

Denise Handlon 4 years ago from North Carolina Author

Hi Daryan, first of all let me extend to you my sympathy. It is a difficult position to be in-having a family member that is clearly in need of help and not being able to get that help for him-especially if he lives in a state different from yours.

Second, if you read the process in this hub and some of the comments here you will note that if they are truly a danger then somehow they need to get an evaluation-either through a reputable family physician or psychiatrist; or through the hospital emergency room.

Third, just because someone is schizophrenic does not necessarily mean they are a danger to themselves or others, and the courts are reluctant to lock someone in a psychiatric ward for a 'maybe'. But, if there is enough evidence on the evaluation they will hold them for 72 hrs for further (and closer) evaluation.

The question: how do we get him help is the real one here. The simple answer: get him committed. The difficult part-yoiu have to be in the same state if you are committing him...or, you have to have cooperation from someone you know who is affected by the outcome of his behavior.

Other than that, you can ask him to come to your state and observe and then commit him from your state. Or, let nature take its course, call the police and let them know what you suspect (his local police, not yours), and perhaps they will check on him. And, pray, if you are religious person.

I know that may all seem very futile, however, there are reasons why laws protect the mentally ill. So...if you are so inclined, I would love to hear back from you with an update. Thanks for stopping here to ask this important question. Best of luck to you and your family.

Britt 3 years ago

what would you do in the situation where someone who had an accident a few days ago is having extreme amnesia? This person understand they are having amnesia but does not want to go to the hospital, it has to be on their time. But what if "their timing" is too late? What can I do?

Denise Handlon 3 years ago from North Carolina Author

Britt-having amnesia is a serious condition. Your friend needs to see a physician as soon as possible. I'm not sure how you are going to persuade him/her, but commitment process for mental illness is not applicable here. Good luck to you.

JWood 3 years ago

my sister recently started experiencing issues with her 18 yr old step son. He came to live with my sister and his father a few months ago. She noticed that he didn't want to take showers or baths and he was not taking good care of himself as far as hygiene is concerned. He recently started talking about killing himself (cutting his throat), being picked up by the police because he killed someone after kidnapping them, he even cut his hair (he had long dreadlocks). He would sit and look as if he was lost in space and many times thru out the day he was on his knees praying and asking God to forgive him.

After insisting that he needed to be taken to the hospital, they finally took him just to have a Dr say that he was faking and all he was doing is seeking his father attention. He was released within 24 hours.

They have taken him home and he continues to say that he is a dead man walking, continues to say that the police will come pick him up and put him in jail for life, he continues to talk about a court date that doesn't exist and now he is saying that he sees people (family members that live in the same home) in hospital beds crying because they are in pain.

My sister is very afraid. We have never had to deal with anything like this and the fact that the hospital released him with no medication just a mental health follow up in a week and a half concerns me. What if he hurts someone? what if he hurts himself? What else or who else should we talk to in order to get him properly evaluated? I dont see an 18yr old man seeking attention from his father by saying or pretending he is crazy. They even found a very thin scar under his neck the day he was admitted to the hospital as if he attempted to cut his neck, however the scar was very thin so the doctor did not take that into consideration. Is there something else that we can do to get him help? counseling? therapy? he need s help and we don't know what to do since the hospital basically said take him home and if he talks about hurting himself have him call this number...

PLEASE HELP US BEFORE ITS TOO LATE!

Denise Handlon 3 years ago from North Carolina Author

Hi JWood, I'm so sorry to read about this family difficulty for your sister. I believe that this young man is in need of psychiatric help. It is very frustrating when families cannot get the help they are seeking when they suspect someone is mentally ill.

I suggest a these things: do follow up with the outpatient appointment. If it truly is only a week and a half then it should be ok to hold off until he sees someone. HOWEVER, if there is any indication of imminent danger than take him back to the Emergency room and insist he be psychiatrically evaluated.

A second option is to go to the courthouse and inquire there on how to fill out the paperwork for Involuntary Commitment. Your sister, or her husband, can be the petitioner and they will have to write down the things that have occurred: threatens to cut his neck, unpredictable behavior, poor appetite, poor sleep, etc. Whatever it is. Then see if they will honor the petition to bring him to the nearest psychiatric facility for an evaluation.

A third approach, if the nephew of yours is agreeable, is to have him visit his primary doctor and tell the dr that he is feeling suicidal and would like to be referred to a psychiatric hospital for evaluation.

On each of these suggestions, whether it is in the outpatient therapy app't in a week and a half, or in the PCP office insist that your sister enter the area with him to give her account of the observations.

In addition to this, tell your sister to keep a journal and dates of behavior she thinks is abnormal or inappropriate, frightening, threatening, etc. Tell her to take that with her whenever she gets in to see a mental health or family physician.

A fourth approach is to get your nephew to agree to volunteer to enter a psychiatric facility. Do that by finding out where the nearest 'behavioral health' hospital is in his area. If there is not a full facility many, many times general hospitals keep a unit or two set aside for mentally ill patients they admit inpatient. Everything is confidential, however, and if he is admitted to a unit for observation he will need to sign a release of information with his dad and stepmom's (your sister) name on the paper to get any information from the dr. He will also have to give them the security number or code in order for them to allow visitors or phone calls.

If he is still a minor and under age re: a high school student you will be looking for an adolescent unit. If he has already graduated, it will be an adult unit he would be admitted to. Being in a psychiatric hospital is very different from a medical hospital so don't be shocked with the strict rules and structure.

I wish you and your sister the best, and please contact me once more to let me know of the outcome...or if there is anything else I can do for you. BTW-what state does your stepson live in?n

Incidentally-the references about the police indicate that he is paranoid, which could be drug induced. Does he take street drugs? Has he been tested for any? He may or may not admit to anything, but that can lead to a psychosis.

Matt 3 years ago

Eyes wide open... Listen and Learn.. Yup

Denise Handlon 3 years ago from North Carolina Author

Hmm, while that is a wise philosophy to follow, things are not as they always seem to appear...thus, the practice of a check and balance system.

Thanks for your comment.

E.J. 3 years ago

I am here because I have confessed to a now Ex about my Bipolar Schizo-Affective disorder.

After having a text argument over the past couple days, his method of retalliation is to threaten me with having my arrested for psyche evaluation.

I want to know what laws protect me from false, "just for the hell of it" claims made from a spiteful Ex?

Denise Handlon 3 years ago from North Carolina Author

EJ I'm sorry that you have been a victim of your ex's vindictive spirit. There are laws that protect people from this type of action. The law states that one has to be incapacitated to be involuntarily committed. As this article states, the terms of that are: A danger to themselves, a danger to other people or an inability to function on their own with grave consequences if no intervention is taken.

Even if your ex feels that you qualify, the magistrate who signs the petition has to have solid examples. Now, the problem is he could lie. He could petition you and state that he has witnessed you stating you want to commit suicide or harm another; he could lie about anything.

I'm not sure if he will be believable. But, let's just say he has gotten that far and the police arrive at your home, (or on the street, because that has happened, too), and you are driven to the hospital ED. Here is what you can expect to happen: Either the hospital Dr or a therapist who is trained in psychiatric evaluation role will do exactly that: an evaluation of your mental status.

He / She will ask a number of questions about your mental stability, your living conditions, employment/disability, home life, (current, not childhood), any stress, suicidal and homicidal thoughts, depression, maybe anxiety, drug use, alcohol use, psychosis, hallucinations, etc.

If you are stable and functioning towards the healthier end of the continuum between mental health and mental illness, you will not be held in the hospital for further evaluation.

On the other hand, if your mood or mannerisms are erratic, show evidence of disjointed thought process, hallucinations, delusions of grandeur or paranoia, then they may decide to hold you for further eval. There is also a decision that is made by ED docs after reviewing patients who have been former patients of that Behavioral health system, who have been non compliant with medications and whose decomposition of behavior is evident, to hospitalize that patient for stabilization and resumption of medications.

EJ, you have nothing to worry about if the case of 'stability', is your situation. If you are actually picked up, brought to the ED and seen by a Dr remain calm, polite, cooperative and explain the situation.

If they do admit you based on their findings, remain calm, cooperative and understand that there is a process even if hospitalized.

You do not mention if you have a past history of hospitalization, suicide, psychosis or homicidal or violent behavior, so I really only know you from the info you've provided. Therefore, if NONE of that pertains to you, it is VITAL that you remain calm, logical, nonthreatening, and cooperative.

Trust me, as one who has had MANY years working in the mental health field, the staff will observe everything about you: your conversation, how you relate info depending on your mood, your feelings-anxious, (rightfully so), angry at ex, (rightfully so), etc. Your job is to NOT give them anything that anyone who does not have your diagnosis would say or do.

It's ok to be upset, if you are hospitalized, but the staff is not part of the decision making process, only the docs are.

Scenario: you are picked up by the police; brought to the ED and admitted to the hospital for observation. If you have a choice and they are pushing admission, and there is no concern about depression, suicide, etc you can choose to sign in voluntarily.

Voluntary admission allows the docs to evaluate you further and gives you the right to ask for a discharge (this is called a 72 hour request for discharge). HOWEVER, if you go the voluntary route DO NOT, and I emphasize this, do not sign a 72 hour notice the minute or even the day you arrive. Why? Because that shows an erratic decision. Wait until you meet your lead doctor who will handle your case. (That may not be until the next day, but you are REQUIRED by law to see a psychiatrist, for a history eval-whether or not it is your lead dr or a substitute, within 24 hours of arrival). So, once you meet your DR you will ask what he/she thinks of your situation and the suggested date of release. If the answer comes back 'a week' or whatever, you can then ask WHY the length of stay. If you are not satisfied, you can inform the dr that you will be signing a 72 hr request to leave.

Part of the information gathering will be from a social worker to a family member or, if you grant permission, to your ex. Hospitals really do not want to keep patients in unnecessarily. However, there has to be a discharge plan in place before the medical team feels comfortable with letting someone go, especially someone they are not familiar with.

That said, IF (go back to the ED now for a moment), the dr in charge refuses to let you sign in voluntary; refuses to release you, and wants to admit you as an INVOLUNTARY patient, again: stay calm & cooperative; ASK WHY and listen, listen, listen to the answer.

If you are sent to the behavioral health unit there are a few things to keep in mind: you will still be seen by a DR within 24 hrs who (should) ask a history and what brought you to the hospital. You cannot, CANNOT sign yourself out in 24 hrs. HOWEVER, you will be allowed to sit before a judge who will determine if you need further psychiatric care, or if you can be released. This can occur anywhere between 5-10 days, depending on how the court system is scheduled.

Court hearing info: 1. An officer of your resident county will serve you papers stating you are committed and can go before the judge. 2. A staff member or social worker will tell you when your court date is, (if not, ask). 3. A judge will listen to the evidence which will include the Dr, SW, testimony of your behavior, as well as documented notes of the staff. 4. You can accept or refuse to talk with the judge directly, by attending the court hearing. 5. You can elect to have an attorney there and a family member for support, (I believe this is so...not 100% positive on this point). 6. The judge will listen to all and make a decision on the spot.

If the judge elects in your favor you must be released at that time-long enough to get your items from the hospital and leave.

If the judge elects for further treatment you will have to stay, per the law, for no more than the allotted time he has stated. Usually, if the doc says '14 more days', (just an example), the docs release a patient before that.

I'm going to assume your ex has NO grounds to commit you and its a big show of intimidation. STOP arguing with him; stop communicating with him-he is an EX; remain calm and make an appointment with a counselor to review this anxious event...it may take up to 3 months to get an app't off the cuff, unless you already see one; or if your primary dr can refer you to someone.

If you are on meds and have not been taking them-that's even more of a great idea to talk with your family dr to get a referral made for a psychiatrist.

If your mood is erratic-the meds will help if you get the right one. Do not let yourself be intimidated by threats. If it happens that he goes through with his threats and he is successful, use that time as a way to re-evaluate things in your life.

I know it is a frightening idea to be locked up in a psychiatric hospital for no reason-so if there is no reason relax and visualize the best outcome. If there is a reason, it will be for your benefit.

I hope this response helps you in some way. If you have a moment, write back in a few days and let me know how you are. I'll be thinking of you. Take care, --Denise

Lorraine 3 years ago

We have been trying for months now to locate a decent, reasonably priced mental health facility that will take in our friend, make sure she gets her meds regulary and can talk to a psychiatirst on a daily basis to try to bring her out of a very severe bipolar manic episode that has been going on since April this year. All they do in California, unless you can afford the minimum of $20,000 per month, is send them for 72 hour lock down to a drug and alcohol rehab institution, where the so called state paid shrink visits once per day for five minutes to review medications , then leaves to make big bucks in his private rich practice. After 72 hours the ill person is released to go right back out and get themselves in danger and/or trouble, Medicare is useless, and if you do not have a very expensive, good private insurance, no treatment is available other than repeated trips to the 72 hour lockdown program if you become so manic you are a threat to yourself or others....it's a revolving door with no help and no end.....and it's going to get much worse,,,,if Obamacare is so damn great why did all of the u.s. government politicians exempt themselves and their big donors from it,,,,even the Canadian doctors who already have "socialized medicine like Obamacare" warns us,,,,we do not want this in our nation as "it does not work"

Denise Handlon 3 years ago from North Carolina Author

Hello Lorraine-Mental Health has been dealt some horrific blows in regards to assistance for 3 decades now. It has been steadily getting worse, and the Obama administration with its current health care options is far from the leading culprit. Back in the 80's there was a huge shift in the reimbursement of health care to hospitals and doctors because of so much fraud. In the '90's, additional cuts resulted in the closing of nationwide community health care centers, as well as the state facilities and private sector hospitals. I know from experience, because I lost a job in Michigan when this happened. Again, long before Obama became president.

I'm sorry about the situation with your friend. It is shameful, and yet there is so little solution for this type of health risk...and I mean health risk. I know what it is like when a bipolar patient becomes euphoric and it can be a life threatening situation.

I wish I had a better answer for you, but my suggestion, as frustrating as it seems, is to keep trying to get her into a facility-even for 3 days, and do a 'revolving door' admission process for her until she stabilizes. If there is more than one hospital in the area, take her to each one...the law requires some help-a patient cannot be turned away. And, perhaps you will find the right place that will keep her longer than 3 days.

I'm not sure what end of CA you live in, but there are reputable facilities that do take patients on a gratuity basis. Best wishes to you and your friend.

Denise 3 years ago

What's worse is they put mental ill people in prison if they commit a crime these people belong is a hospital not a prison they need help before they commit a crime not after mental illness you don't think we'll as someone with a well mind

Denise Handlon 3 years ago from North Carolina Author

Hi Denise, I agree. There are many incarcerated prisoners who are mentally ill and not receiving the treatment they need. Thanks you for reading and commenting.

Gabe 3 years ago

This is a sick joke. If 1 in 3 were mentally ill you would see chaos first hand on a daily basis, I mean see it first hand and not b.s. news stories. Why does every human personal issue have to be diagnosed? It is a control mechanism used in dark parts of history by Nazis, Soviets and almost every regime that has tried to steal freedom from a society. It is also an industry that has the luxury of building itself up as it fabricates more creative names to label what used to be simple human issues that people figured out on their own. It is also a common use for revenge and is used by pedophiles to control their victims throughout life because mentally ill don't have validity. Truly sick

Denise Handlon 3 years ago from North Carolina Author

Thank you Gabe, for visiting this site and sharing your thoughts. Sometimes the truth is difficult to bear. I appreciate your comments.

A Concerned Citizen 3 years ago

Hello Denise –

I checked myself into an emergency room voluntarily about a year ago in Arizona because my bipolar medications had become imbalanced and I recognized that I needed some help getting them straightened out. From the moment that I checked myself in I became a prisoner in a nightmare that lasted for the next 28 days… I was transferred from facility to facility to facility, never permitted to see a judge for the entire time, and never permitted to review my records either before or after my stay. Even though I put up no resistance to treatment and was not hostile toward the staff in any way I was strapped down onto a gurney and experimented on against my will with psychotropic drugs. After my release I tried to find a lawyer to represent me and 9 out of 10 would not return my phone calls – the only one that did was way out of my price range, so despite the nightmare that I lived through I was never able to find any sort of unbiased legal representation either during or after my experience.

While I was on the inside, the social workers would report back to me decisions that the court had made on my behalf but by far and large the court acted in secrecy. I am just writing to inform you that the protections that you cited in your article are no longer necessarily followed by the legal system that doles them out… Despite the fact that

I am a peaceful person whom had checked himself in seeking treatment – I was treated like a terrorist because nobody was there to protect my rights. I was repeatedly denied access to a human rights advocate and mistreated with both physical and emotional abuse by the staff on numerous occasions.

A Concerned Citizen

Denise Handlon 3 years ago from North Carolina Author

Dear A Concerned Citizen. I'm appalled of the facts you state here. I will tell you that in my experience as a mental health nurse, there are conditions that it is inadvisable for a pt to attend his own hearing, but this is rare. I'm not aware of any of the places I've worked, including one of the county facilities in California known for difficult and chronically psychotic patients, where patients are not asked if they want to go to court. This is their legal right. They are served papers and the court date is printed clearly on the paper.

How AZ could get away with this is beyond me. You are also given the right to access to your medical records, however you would not be able to view those until after your discharge, and it often cost a fee, plus it takes a few weeks to receive them. No place can prohibit your ability to review your records. In fact, I've requested my nephews hospital records from his birth, fifteen years ago, when there was a malpractice situation going on. This was four years ago and they sent everything.

I would suggest a couple of things. Follow up with your own psychiatrist to maintain rapport and to keep stable on your medications. This is especially important to avoid another painful incident of the one you have had.

Second, I would suggest getting your records, if you are still interested. I'm not sure what other suggestions I can offer, other than to validate that your experience sounds like a nightmare. I hope that, whatever peace you can find from this admission/hospitalization, will be forthcoming to you.

Thank you for sharing your situation here. I wish you well, mentally and spiritually.

A concerned Mom in PA 3 years ago

My 18-year old daughter signed herself into inpatient treatment a month ago. She spent 2.5 weeks there before coming home a little over a week ago. It has been a rollercoaster of emotions for her and our family, but she was "fighting" her depression and anxiety disorder. She regularly took her medication, and was working hard to use the various coping strategies. After a disappointment yesterday, however, she took pills and made a suicide attempt. She has since been transported to another inpatient facility, where she has signed some sort of paperwork that prevents me from seeing her or being updated on her condition. She's angry with me (and our family) for not complying with a request to call a friend while she was in the ER. I can explain our reasons for not making that call, but please trust it is not in her best interest. Do I have any legal recourse to at least be given the opportunity to receive updates from the medical staff that she is ok?

Denise Handlon 3 years ago from North Carolina Author

Hello Mom, I'm afraid that the simple answer to your question is "no". It is heartbreaking when a child of her age is allowed to make adult decisions but for her own reasons shuts out family members from support that could be available in the long run. As you are aware, eighteen is considered an adult in the eyes of the legal system. However, as parents, we know that 18 is still a long way to go in life experience before a 'child' of ours is truly independent.

It is also a time of great change and transformation, and some children transition with less anxiety than others. Please keep in mind that your child is NOT the 'sick' one in the family. She manifests the dynamics within the family system. Each member of the family contributes something to the family structure and when one is 'failing' or filled with anxiety and depression, others react and are affected. If at all possible, see if you can reach out to the medical team (there is always a lead psychiatrist and social worker, as well as the nursing team, that is assigned), and it will probably be the social worker that you will have the most success with. The difficulty may be getting the 'security code' or security word to have them acknowledge your daughter is a patient there. Even that will be hidden unless she decides to share it.

A couple of things: she can deny a family meeting, however, it is worth a try, especially if she is expecting to return to the home. If you cannot reach 'her social worker' leave a message with the secretary that you want a phone call from the social worker. Again, it's a 50-50 chance.

Second, the fact she is angry for something that you have decided is NOT good for her indicates there is a power struggle between parent and child. She has the right to contact this person, however, you have the right to tell her-go ahead, but it won't be from me.

Part of the transition at this age is deciding whether you are willing to see your child as an adult and treat her as one, including choices and consequences, or are you going to keep the inevitable (growing up) a resistance and struggle through the years.

If you choose to have a healthy relationship with your daughter understand that there will be choices she makes which you won't agree with. If she lives under your rules you can explain the expectations and the consequences. If she does not abide know before hand what your limits are and follow up so she takes you seriously. If she wants the safety and support of family without paying her dues, but does not want to follow the rules, she wants it all her way. So...that is just part of the dynamics. Kids can be pretty labile and fickle with their anger. Sometimes it is drama...but, sometimes it is justified. Since I don't have info on her side of the situation, I certainly cannot comment on a right or wrong.

In the end it boils down to her anger because you did not do what she asked you to do. And, if you are positive that this call was not in her best interest, then she can take or leave your explanation, and like all children, hold a grudge and pout if there is a conflict of values in your household. You do not need to compromise your values, but COMMUNICATION, explanation, and standing by your decision goes a long way. In fact, talking and actively hearing each other in households are definitely two skills that most families lack.

I wish you the best and I would love to hear the outcome of your attempt to contact the medical team/social worker to work through this. Please, request a family meeting and see where this goes. Best to you and your daughter and family. I hope this helps, even though I know this is not the answer you were hoping to hear.

writewoman 3 years ago

On the news almost daily we hear of mentally ill people shooting up public malls, movie theatres, and schooIs. In every case, the question is asked: "Why didn't someone do something before it came to this?" My question is -- What can a responsible observer do??

Online, that question is met with articles about the "rights of the mentally ill", "disability benefits for the mentally ill", persecution of the mentally ill, misinformation or prejudice against the mentally ill, or articles about how so few are a true danger. Authorities claim they can't be committed against their will unless they have already engaged in some act that is a danger to themselves or others. What about society's rights? How do we protect ourselves from those few dangerous ones if there isn't even an agency to whom to report or from whom get help to prevent acts of violence?

Denise Handlon 3 years ago from North Carolina Author

Dear writewoman - yours is an excellent question, which many have discussed and pondered...the system has failed, that is my opinion and the opinion of many of my colleagues. I wish there were a quick, simple answer. It seems there is so much rage in our society that even people who are not classified as mentally ill can reach their breaking point.

The situations which have been in the news of such horrific levels of mental illness and missed opportunities, it is both disturbing for the mind to try to comprehend, and almost an impossibility.

When I read that police officers receive calls from a man with a mental health history who is claiming that he is hearing voices, and yet, they don't investigate...it saddens me.

I'm not sure what a responsible observer can do. I'm not sure what we as citizens can do to protect ourselves and our children, while attempting to live our life. It is a sad reflection of how out of control our society is on many levels.

I know it is frightening, frustrating, and in many ways, a sense of hopelessness. Again, you raise a great question, and I wish I had an answer, however I don't. Like you, I live in this world hoping to get through each day without becoming someone's target. I wish you well in your search for your peace in this equation of sickness. Thank you for writing.

Writewoman 3 years ago

My paranoid schizophrenic brother (undiagnosed and untreated) may well become the next media mass-murderer. He believes he is surrounded by demons who mean him harm. Efforts to get him to seek help only fuels his paranoia. I have notified the police to hopefully prevent his purchase of firearms, but because of "his rights", he must commit some overt act, even a direct threat, before the police can intervene. Meanwhile, everyone who knows my brother's mindset is their locking doors, holding their breaths and feeling like a sitting ducks with no rights whatsoever. Society's measures to protect the insane are themselves insane!!!

Denise Handlon 3 years ago from North Carolina Author

I understand the terror you are going through. Waiting for a train wreck to happen when it can be avoided through the conductor's switch is maddening and madness! I don't get it. So...can you go to the magistrate in his county of residence and file a petition to commit him for at least a 72 hr evaluation? That is the only thing I can think of at this time. The 'cause of the IVC (involuntary commitment) would be: threatening others caused by his paranoia. Is he experiencing any hallucinations? If so, add that to the 'threat of safety'. Let me know...

Jennifer 3 years ago

My husband self referred himself to a mental hospital for thoughts of suicide now that he has had time to think things through he's wanting out how can he get out?

Denise Handlon 3 years ago from North Carolina Author

Jennifer, it's easy getting in to a psychiatric hospital, but not so getting out. Here is what his options are:

1. Ask the doctor who is following his treatment, (when the doc makes rounds), to release him based on not feeling suicidal any longer. He will have to explain to the doc how he feels, what happened, etc and that he will follow up with outpatient therapy. Then, HOPE that he is released that day or the following, but based on the circumstance of his situation, this may or may not happen. It depends on whether he had a suicide plan, and a means of carrying that plan out. That is called the seriousness or lethality of the situation.

2. Explain to the doctor what happened, hope he releases him, and if he does not indicate that this will happen within 2-3 days, ASK when he will be released and follow the guidelines of the unit schedule and expectations. A psych hospital is very different from a medical ward. They are expected to get dressed in street clothes, stay out of their rooms and participate in activities like group therapy. The more he goes along with it and is compliant, the better his chances are. The most important thing is that he be upfront with what brought him there and how that will be different when he is released. He may be asked to start an anti depressant medication and to tell of his family history of depression or bipolar symptoms. Let him know that this will only enhance his ability to cope better when he is released.

3. He may really have a problem that he is minimizing and the doctors may evaluate that he is actually a higher risk. Anytime a doctor feels a person is in danger to himself or others, he has the authority to involuntary commit that person, even if the person came in on a voluntary basis.

4. ****This is the one he may want to utilize to his advantage for release

If he truly did sign in voluntarily, and was not committed, he has the right to sign himself out. If he signs a request for discharge form he has a 72 hr waiting period before he is released. This three day period is to allow the doctors and medical staff to observe, discuss and determine if he is a danger to himself or not. If he is not, more than likely the dr will just release him that day or the next. If it is undetermined, he will probably have to stay the 3 days to clear himself, and would be released after that time period.

Now, there are 2 things to keep in mind with this option. First, many patients come in thinking they signed in voluntarily, but in the E.R. the medical examiner signed a petition to commit and he may have been admitted on an involuntary status. He has to double check his status with the nursing staff. The second point is that many states, (not sure where you are), have a 72 hr holding NOT INCLUDING weekends and holidays-so, business days only. That means that if he entered the hospital on this past Friday, Nov 8th, and was admitted voluntarily by a state that does not include w/e's or holidays, his first 24 hrs would extend from Fri to Tues, due to Nov 11th Veterans Day. So...there are certain loopholes in some states.

Best to have him check with the staff or his doctor and sign the paperwork if he wants a guarantee release, (if he is stable and safe), OR, wait to see if his doc will discharge him the next day, again, depending on his circumstances and endangerment.

Best to you and your husband. Please follow up with me in a few days...I'd love to know the outcome. Thanks for your question.

A concerned Mom in PA - update 3 years ago

Thank you so much for your response - I wanted to let you know that I unfortunately did not have any success reaching out to the medical staff. The nurse and social worker insisted their "hands were tied" and there was nothing they could do. But fortunately, my daughter changed her mind on her own and granted permission for me to openly communicate with her medical team the next day.

My approach was (and continues to be) exactly as you stated in your comments - "go ahead and contact them if you choose, but I will not be doing it for you".

She is now home, and I am eternally grateful for the opportunity to build a stronger relationship with her...far too many parents of a "depressed teen" do not get the opportunity that I have been granted.

Thank you -

Denise Handlon 3 years ago from North Carolina Author

Dear Concerned Mom I am so grateful that you've given me an updated report and that you see the value of the gift you've been given. How very true that many parents lose their depressed child instead of being able to have them live and grow from the experience.

Usually, in my experience from working with thousands of patients through the years, a person on the psychiatric unit really does not want to be estranged from family...especially a young woman your daughter's age.

Thank you, again, for the update and I wish you both well in the transition of a more mature relationship. God Bless.

need advice, need help 2 years ago

I have an 18 yr old son whom we had to place in the psych department at a local hospital. he threatened to burn down our house while we were sleeping. And take all of his medication at one to end his life. we have been dealing with things like this since he was 12 or 13. He was almost put on a terroist list at a high school for threatening to kill a couple of students, but he wasn't. That was a couple of years ago. Then the other day after threatening to burn down my house he threatened to kill a couple more students at another school. We admitted him that night. he is verbally abusive and disrespectful to us as well as his two sisters one older and one younger. He has also been physically terrorizing them. He steals from my husband and i giving my jewlery away to girls so they'll like him. We have tried medication, therapy. Everything that we know. But it has come to the point where my husband has had enough and is saying that he is leaving. My daughters dont even want to be anywhere near their brother he scares them and is tired of living with him. I get nervious that he's going to hurt someone some day, he lives in a fantasy state of mind. I have had panic attacks and nervious breakdowns due to his outbursts and threatening to kill people. Im afraid that the hospital will make me take him back home where I dont feel safe with him there or leaving my daughters with him there. Can they make me take him home? what can i do to prevent that from happening? I don't have any family that can take him. And i cant continue this way.

Denise Handlon 2 years ago from North Carolina Author

Dear 'Need Advice' The short answer is "NO" unless you are legally obligated and responsible for him, such in cases of guardianship. I'm wondering if you ever sought mental health treatment on an outpatient basis and also, if you have shared these very frightening experiences with other members of your extended family, your minister/priest, and/or the police. I'm assuming the police are aware or there would not have been a threat to put him on a terrorist list.

Good heavens, it is so dreadful to go through this, whether with other children in the house or not. He cannot be allowed back into the house while he is so unstable. It is not fair to you or the rest of the family members.

He is an adult, technically. He can be asked to leave your home without repercussions. You need a diagnosis (sounds like schizophrenia) and just because someone in the family has a mental illness it does not make you responsible for taking care of him for the rest of his life.

Of course treatment is preferred over jail, but he is a menace to your family and society. Keep him in treatment as long as possible; preferably long term inpatient treatment, but good luck with that. When it comes to discharge, get him into a group home and into the mental health 'system'. Keep him there. Visit him but under no circumstances trust that he is A okay. This is one of those unfortunate situations where I will go out on a limb and say he will never be as normal as your other children.

Please let me know how you are doing with this problem as the week unfolds. My best wishes to you, but protect your self. Thank you for writing. BTW Is he still in H.S.? Just think of all the horrific things that happen in the news because people are missing red flags and give yourself credit for seeing them and trying to do something about it! Take care.

Somethingxpretty 2 years ago

I have been diagnosed as bipolar, I have panic/anxiety issues, and have PTSD from childhood trauma. I am a very rapid cycler, as in I cycle anywhere from a few hours to a few days. I could never hurt myself or anyone else, but there are a few things I have never told any of my psychiatrists. I see faeries flying around my room at night, I hear music when I am the only one home and did not turn a tv or radio on, I sometimes see spirits of my deceased relatives, shadows dancing on walls, definitely strange, but there's nothing violent. I've never told anyone at all about what I see/hear because I'm afraid my psychiatrist might commit me involuntarily. I live in Texas, and it's gotten to the point that I can't work or leave my home due to the increasingly rapid cycling. Relatives bring me groceries, and my home is not a danger. It's not tidy, but it is not a health hazard. I bathe every other day or 2, and I do not use illegal drugs or alcohol. Can I be involuntarily committed? I believe it would cause more harm than good.

2. filled with anxiety and agoraphobic (afraid to be out in public) and

3. So fearful that you will be involuntarily committed that you would not share this info with your psychiatrist.

I'm glad you've had the insight to look into this problem, because it is obvious to me that you do want help from this difficulty.

I'm wondering if you have ever been hospitalized for this bipolar/anxiety/PTSD problem? If not, there is a huge difference between being committed inpatient and when volunteering to be admitted.

I would like to ask you a few questions and if you could respond with a second message to me, that would be great. Otherwise, I will hope to answer all of your questions here.

1. If you are NOT a danger to yourself or others or living in squalor which someone may report, then NO you would not be involuntarily committed. That said, there are ways that people here in NC have been IVC'd due to allegations made from neighbors or relatives. So, ideally, you would not be committed.

2. Since you have already stated that you are anxiety/panic ridden, and cloistered in your own home, I'm going to assume that you do not like this life and feel it is not a quality of living you would desire. It's important that you share your visual/auditory experiences with your psychiatrist. It may be that you are hallucinating and the medication you are currently on for Bipolar, which would be a mood stabilizer, is not effective for a psychosis. You may need a medication adjustment and/or need an additional medication.

This is what I would suggest: I would talk with my psychiatrist and explain the additional symptoms you are experiencing and for how long. I would ask for him/her if it would be possible for an inpatient referral to be made.

There are many patients who admit themselves based on the need for a medication adjustment. Given the fact that there is a rapid cycling, and the additional component of sensory experiences, there is just cause for hospitalization.

Hospitalization to a behavioral health unit, (psychiatric), can be one of two kinds: voluntary and involuntary. With a voluntary admission you sign papers consenting treatment. If you should decide you no longer want to be there after a few days you have the right to sign yourself a 72 hour notice of request for discharge. When a patient signs a 72 hr notice the hospital psychiatrist is notified and is allowed '72'hours from the date/time of signature to find reason to keep the patient in the hospital. If there is no reason to keep the pt inpatient due to danger to self or others, then the Dr. is required by law to release the patient.

An involuntary patient does NOT sign himself in and CANNOT sign himself out. He is there for the course of the hospitalization.

In your case, you would be able to go into the hospital for treatment via voluntary. But, it's important that you share the sensory experiences with your doctor. A pt to dr relationship is built on trust. I'm wondering if you do not trust that your doctor will handle the situation fairly?

Best wishes to you in this dilemma. I hope to hear back from you. Thank you for writing in.--Denise

endrun 2 years ago

This is a very well written piece promulgated as per usual by folks who do not know or understand the situation they are talking about.

1)There are NO checks and balances which exist in the process of what is referred to as "civil commitment'(which is in fact imprisonment without a trial and protections for the criminally charged that we have in this country). The state laws are often designed to provide checks and balances but are routinely ignored as a matter of course by those participating in this process. There are no legal protections sufficient to counteract the huge actual abuse of discretion that occurs every minute of every day in this country across this country by those who run the so called mental health system(what they promulgate is mental illness, not mental health, BTW!).

2)When you state the Dr. is "required by law to release the patient", this does not happen. The hospital is in business to make MONEY. So is the Psychiatrist. So are the staff on the wards. So is the pharmaceutical company that benefits well from these processes. So what you are talking about is LEGAL THEORY. LEGAL FACT IS ENTIRELY OPPOSITE.

3. Voluntary patients almost never--EVER---can sign themselves out. The reason they cannot do so is they are all QUICKLY CONVERTED TO INVOLUNTARY ONCE IN THE HOSPITAL. PERIOD. So this is incorrect also.

A Psychiatrist who never believed in the power of Psychiatry to involuntarily commit a person or indeed do anything to a patient that did not require his consent, wrote several books on the subject. One such book he wrote was titled "The Therapeutic State". He closed this book with these words, absolutely objectively prophetic, written in 1989 but held for several decades prior thereto:"Once people rushed to embrace the Totalitarian State. Today people are rushing to embrace the Therapeutic State. By the time they realize that this State is one that is about TYRANNY and not THERAPY, it will be TOO LATE(emphasis added).

AMEN!!

Denise Handlon 2 years ago from North Carolina Author

Endrun, I appreciate your opinion on this subject and am curious if you liked it and found it useful and interesting? It appears that you may have had first hand experience on an inpatient 'ward', as you have named it. These may still be considered 'wards' somewhere in the world, but my experience through 30 years of working in the mental health systems have seen this term transition to 'unit'. They are units in specialty departments in progressive hospitals.

While I will agree that some hospitals offer better care than others, I have worked in mental health facilities from Alaska, to North Carolina and in between. Nowhere, in any state, did I not observe psychiatrists following the law. Whatever negative experience you have received in your life time, I am sorry that this has created such anger and animosity towards those who attempt to help mentally ill people in need.

When people are hospitalized against their will...as an involuntary patient, there can be ill feelings directed to the medical staff and anyone who was involved in the hospitalization process. This is NOT the same as imprisonment in a correctional facility, and you are in error to make this comparison.

You are also in error about the voluntary patients not being able to sign themselves out. In all but one case in our facility in the 2014 year, any patient who chose to leave after their 72 hr evaluation was up did so. That was a total of 5 out of 100 patients who signed themselves out vs one who was involuntarily committed. That was in our facility alone, not including the facilities across the nation. Again, it is obvious to me that you are angry, upset and are speaking out from your experience and opinion of that experience.

In regards to your book reference, 'The Therapeutic State', I have not read this book, nor have I heard of it, so I cannot form an opinion about the information available in his book.

Again, it is truly a shame that in your experience, you have not found anything beneficial nor have you found the overall system to be worthy of helping those who have reached the end of their hope.

Thank you for your comments. I have noticed that you have been a member of Hubpages for two years and yet have not submitted any articles, followed any hubbers, nor have had any hubber except one, follow you. Perhaps this topic would be a great way to start your contribution here as a writer. Best of luck to you.

endrun 2 years ago

1)Oh, so they are no longer "wards" but instead "units". They are also no longer "loony bins" but instead the euphemistic "behavioral health services." Bulldump and baloney on the euphemisms:"you cannot turn a sow's ear into a silk purse merely by changing its name".

2)It functions in most ways exactly like a prison--where the guards punish prisioners who step out of line, and treat them like animals. Curious that you deny this absolute fact after you were employed in the system--but I guess that HAS to occur otherwise how could anyone who worked their LIVE WITH THEMSELVES?(I cannot FATHOM it).

3)You posit an abjectly bogus argument, which is what we hear over and over again in our efforts to stop the insanity from Psychiatry:oh, I am so sorry for your experience, but my experience is exactly the opposite. I would ask you to look over your experience a bit more and dare to drop your defense mechanisms and look closer at what you do and how disempowered the lowly patient is in that system such that this is defined by the U.N., the Organization of American States, and the World Health Organization as "torture." Oops another indelicate word but this is the designation of THOSE organizations, not mine. Of course those running the system would prefer that word to be "treatment". It amounts to torture in most cases however.

4)The system is not worthy of so called "helping" anyone. Indeed, it was Dr. Szasz very point that it is impossible to really help anyone when one is acting unilaterally without any meaningful consent in the entire process. (Indeed, once a patient on a UNIT--which is nothing more than what a WARD is, which is nothing more than a JAIL dressed up in eupehmisms that suggest it is "therapeutic" instead(which it is not, and that is provable also--he or she is treated as an ANIMAL IN A CAGE at all times. An animal is not worthy to express any displeasure, which if it is expressed even in a calm manner, the staff is trained to for the most part ignore it. If one behaves in a manner contrary to how the staff has designed preferable behaviors, such as fail to attend an activity, sanctions are issued summarily as a result--there is no process, no due process, no hearing process, and no fair process. If one refuses to consume the drugs that are pushed, the law on this point is of no help to the lowly patient--he is issued sanctions consisting of more jail--oh excuse me, unit time---then he was originally down for.

4)Add to this criminal fraud that is produced regularly and routinely by Psychiatrists running these jails, ehum, units by falsifying records and embellishing the patient's sickness by concocting stories supporting the thesis of being "violence prone", which all employees participate in because they know if they blew the whistle they would lose their jobs and that comes first and foremost.

5)No Psychiatrist in such a setting is ever interested in any fact, miniscule or major, that contradicts the usual thesis of making the patient out to be "maximally sick." I have detail after detail on this. Many Americans are under the false belief that a legal process after the fact can and does work to support some kind of rights for the patient. This is abjectly incorrect. The situation for such patients is far worse in many ways than it was for black people in this country before the passage of civil rights legislations in the 1960's. For them, if you were black you had no rights period. If you are designated "mentally ill" by the system, your rights then exist only on paper and they are always abridged by the system and the courts as well. Always. And this is based upon exactly what Dr. Szasz wrote about starting in the 1950's in this country., which is the air of elitism possessed and granted the so called "expert witness" by our legal system. This is why Lawrence Stevens, J.D., counsels people to avoid the mental illness system at all costs, along with the so called stigma effect. This is more like the "self-fulfilling prophecy effect." You see, it does MATTER what we call things because if we call things by their true name, then we tend to foster truth as opposed to euphemistic baloney.

6)I notice that you, Ms. Handlon, say nothing about the usual injuries meted out to such patients by security guards who, acting under color of law, regularly injure and sometimes kill inpatients when they refuse medication. The Federal Courts have stated patients have a right to refuse medication but circumscribed that right around the usual endless subjective determination about whether the patient is in such dire straits with their so called mental illness that without medication they would be a danger to themselves and others. There is no predictive power in Psychiatry including Psychiatric Nursing to substantiate such claims, yet this is claimed regularly for every such patient regardless of the facts. The real object is to secure monies for insurance coverages for such adventures, not to determine the patient's mental status in any way, shape, or form. It is all about the money. It's the money. $$$

7)I find your assertions straight out of the book of denial. Did you ever actively L@@K for violations of law by Psychiatrists, and were you familiar with the state law regarding the process of involuntary commitment in whatever state you were in at the time? Chances are you were ignorant of the law at least in some aspects, as many employed in the profession are. I will give an example of this. When I as last canned under a false charge of threatening my local Mayor's life--exchanges of which occurred online but of course no one working in the system looked those up(because once again it is never ever about finding the truth, it is about finding a "patient" and "treating" him--and if they looked they would have found that long before I was accused of what I was accused of, that Mayor issued two very specific threats against me on that blog involving abuse of his power--so this was all sociologic political baloney). Anyway of course you will never(EVER) get the staff in the hospital nor any Psychiatrist assigned to you to get the story straight and are always guilty until proven innocent(and you have no chance of proving yourself innocent either). Now ostensibly,

these laws were written at least in part to mollify the public into believing that this system evaluates actual threats and thus moves to prevent those in society once they are found. There was no such evaluation in my experience, so had I actually been out to harm the Mayor this process would have done absolutely nothing about it because it only sought to incarcerate(make an involuntary inpatient) and medicate(ie, "treat"). So it is all patently and entirely a bunch of controlling baloney. Period. That's the fact. And I contacted the local media(which I correctly felt was my only hope at the time), which made a further mess of the situation, as they are wont to do in such "headline outlines."

So on that basis I have to conclude this is all B.S. and it hasn't improved one iota over my lifetime. Because no one cares about FACTS. All they are interested in is "working the system" and any fact really doesn't matter in that context one single iota.

8)Ms. Hendlon, you make no statement about my assertion that the policy is that 100% of hospital beds in such "units" must be occupied at all times. I presume that is because you recognize the veracity of that.

9)If I worked in such a B.S. system, I can tell you my conscience would bother me and probably on a daily basis. Many who do I think choose to ignore the facts because they would be out of work if they chose to face their own consciences about what goes on there and what they KNOW goes on there. Denial is thus an important mechanism for those folks, but let me end by saying this:

"Denial is not a River in Egypt." And one other thing:Heck yeah, if you opened your eyes to the truth here, you would be angry too--righteously angry. Of course your training is to see that as "disease". That is a circular reasoning of denial too!

Denise Handlon 2 years ago from North Carolina Author

I was hoping to hear back from you, Endrun. After reading your response to my response I can feel the anger...or, rage that explodes from your experience. I disagree with you on most of your accounts in regards to private psychiatric facilities. However, I have not worked in state facilities, so perhaps they do have security guards, (ours does not), and stricter restrictions than private facilities.

I support you in your experience and do not agree with your rational of lumping everyone's experience into what happened to you. Thank you for your response.

endrun 2 years ago

WHY, I would ask IN THE WORLD would you DARE to assert that private facilities employ no security guards, and that these then do no injure and sometimes kill patients incarcerated on mental wards? You KNOW it happens....but it seems you are in COMPLETE DENIAL about what your profession represents in terms of the ABJECT EVIL IT SUPPORTS. I do not have a rationale(sp!) of lumping eveyone's experience into my own. It is for this precise reason I never disagree with any patient's opinions, but only insofar as to point out that procedurally the mental illness system is an abject danger to civil liberties, human rights, and has been proven so over and over and over again in state, federal , and international courts of law. There is simply no denying that fact and this is simply because there are NO procedural protections for ANYONE who gets scarfed up into the Involuntary Commitment regimen.

I would also be curious as to whether you support the idea of drugging and hospitalizing(imprisioning, which is a correct word, even though you don't like it) CHILDREN as was done to me in 1968 and is being done to more and more children as time proceeded from 1968 and is an ever-increasing phenomenon.

Denise Handlon 2 years ago from North Carolina Author

Thank you for sharing your experience, or rather, that you were hospitalized as a child. What a frightening experience that must have been for you. No wonder you are such an angry person at this adult stage. The anger is alive in your comments and capitalization of words. Are you yelling at me through this because of what happened to you?

Due to the mass closings of state facilities and mental health clinics people who are in need of mental health treatment have very few options to turn to for help. Whether you agree that this should be allowed or not...it is there for treatment, not some archaic, ancient torture to inflict on other people. I support anyone who is in need of help and who is willing to enter a hospital to receive that help.

My information here is to inform the public. Your experience isn't full of truth or facts in all hospitals. Whatever nightmarish experience has filled you with this rage against society, and apparently, against me personally-or rather the author of this article, I hope you will eventually come to terms with it. However, I doubt this will happen, because of the projection you are throwing out at me. Goodnight sir.

fpherj48 2 years ago from Beautiful Upstate New York

I'm sure you are not surprised to know I am very impressed with this hub. The legal issues in terms of mental health is a powerful topic and you have done it great justice (no pun intended).

How I wish more people were aware of these facts. and speaking of.....it's almost appears as if you hung a shingle on your hub door, Denise! LOL

I'll bet you didn't expect the rush from the outside, laying their troubles and dilemmas at your feet. You are an amazingly patient woman!! Bless you. Once again, Great HUB!

Denise Handlon 2 years ago from North Carolina Author

Hi Paula, thank you for your comments after reading this hub. I am truly amazed and humbled by the number of people who began to write seeking support and information. It has been interesting. Thanks again for your comments. :)

Somethingxpretty 2 years ago

I refuse to be hospitalized. I no longer have private insurance, and I have been to the psych ER several times for med adjustments, some of the people I met there scared the hell out of me. My condition would only worsen, the stress of being in this environment as well as my paranoia in general won't allow it.

have 18 yr old son who compulsively lies and blames other siblings, quit therapy, and dcf left when he turned 18, no one will help he spits on neighbor,leaves windows n screens wide open with fan in window even though heat on swears up down heat not going out window, busts up my stuff in house n his when mad, rent 3 bedrooms from his dad who gives him everything he wants even though he fc up, gives debit card to him, doesn't matter what i do his dad will always win, but afraid gonna end up in box or jail

Denise Handlon 2 years ago from North Carolina Author

Kelley-I'm sorry you are having such a difficult time with your 18 yr old. Bad, disrespectful behavior isn't necessarily a reason to hospitalize someone. Once he has left your home to live on his own he does not need to seek therapy, if that is his choice. If he breaks things in your home, call the police. If you don't want to call the police, don't invite him in your home-it's called tough love. If he becomes a danger to himself or psychotic, or threatens harm to someone else, you can commit him. Otherwise, it sounds like a job for law enforcement. Best wishes to you.

Donna Williams 2 years ago

I have a son who is bipolar he has been in and out of mental hospital for years. Unfortunately he hit an innocent middle age man in the mouth and set on him until police came. He thought the man was attacking his girlfriend. He has not seen her in two years. He run out at night doing thing like holding a hammer in his hand hitting at the air. He thinks people are trying to kill him. He went to jail a few days ago . I told the police that he needs to be in a locked faculty put no one cares. He will end up killing someone or shot dead bye police. Please help me fight the system .

Denise Handlon 2 years ago from North Carolina Author

Hi Donna Williams, thank you for writing. Your son does not sound bipolar, by the behavior you describe. He sounds schizophrenic, or at least, bipolar with psychosis. If he is hallucinating, and is a danger to others, such as the man he sat on, you have the right to commit him when he gets out of jail. It sounds like he needs to be evaluated by a psychiatrist, especially if he has never been seen by one or has been on any medications to stabilize his mood. Please help him seek help.

Hendrika 2 years ago from Pretoria, South Africa

In South Africa Mental Health facilities are very stretched and they keep a person in a normal medical ward before referring them to a psychiatric hospital. Government finances are also a problem so very limited medication is available. If the person needs just a little medication with a difference they cannot help. I suffer from bipolar, but I can not get government out patient treatment because they cannot give me the right combination of medicine. Now, the private sector is bleeding me with payments not covered by my medical aid!

Denise Handlon 2 years ago from North Carolina Author

I'm sorry to hear of your difficulties. I hope you are able to find a way. How interesting that different countries treat Mental Illness so differently. Thank you for sharing your experience. Take care of yourself as best you can.

endrun 21 months ago

"The law protects our independence and self-determination. Imagine how grateful you would be for these laws if you felt you were being unfairly committed to a psychiatric hospital!"

I find this statement meaningless, but I am curious as to what the other thinks it means....

Denise Handlon 21 months ago from North Carolina Author

I'm curious about what you find meaningless about it. What do you think, or rather, do you have any first hand experience of this?

Lmbradley 16 months ago

At 13, my daughter was diagnosed with major depressive disorder with psychosis and later, delusional was added by her therapist. She has been in 7 inpatient facilities from 2008 until 2010. All stays were involuntary as she was always a threat to self or others. She would go from 0 to 60 effortlessly with no specifc triggers. She got into trouble in school often and we have to go to court numerous times. She was doing school on medical homebound and then we tried online schools but she eventually gave up on school. She had weekly therapy sessions as well as visits to the psychiatrits for medication management. She was apart of continuum of care for a while. She went through many psych evaluations and medical tests. Of course her inpatient stays were short. The longest she stayed in one was one month. The doctors had her on so many medications at once. It was unbelievable. She gained so much weight. We started the process of bariatric surgery but she decided she didnt want to do it. At about 16, she told the psychiatrists that she was tired taking medication and she didn't want to any more so she told her it was her choice and from that day on, she has not taken any more medications. She stopped therapy and as the years rolled by, she completely stopped going anywhere. She won't wash or put clothes on. She won't do anything and over the last year or two, she has started talking about strange things and she truly believes what she is saying. She is now 20 and I still caannot get her back into therapy. All these years, we have been trying to be careful of what we say, how we say things, not pushing her because we dont want the violent behavior to come back but we are always fearful of what she will say or do. I was told that I can have her committed but in reading your posts and others, it doesn' t seem to be that easy. And even if I can, it would only be for 72 hours and then what? If they keep her longer, which seems to be only if there is current documentation, if prescribed medicine, she won't take it and she comes home the same way she left. And more angry because of what we did to her. I am at a lost and I have no idea of what to do or how to begin to do it. And she's been committed so many times before, will another time make a difference?

Laurie S 14 months ago

My father is bi polar and a hoarder. He has recently lost is drivers lisence and is still driving. Even tho there has been several opportunities provided to him for transportation he refuses. I can NOT get any one, from medical to juditial to help. He says He will sell his house in OH and move to NC when he gets the house "fixed up". His idea of fixed up is much different than mine. He does NOT care that he is not to be driving or that there are so many tings wrong with the house including electrical and mold issues. I don't know what else to do!

helplesscry 13 months ago

I'm sorry, either I over looked it by accident, or it wasn't stated clearly. Every state has different law. Does a person with no documented previous mental issues, and no current insurance, have the right in north Carolina to walk into an emergency room and put themselves under a 72 hr phsych evaluation and be guaranteed that 72 hrs? If not, can their spouse do something?

Jen p 9 months ago

My husband admitted his self to a mental health ward he was there for 5 days an signed a paper for release he flipped out the night before he got out an was put in the padded room an they still released him six days later he killed himself is there anything I can do

Jessica Purvis 8 months ago from Durham, England

I've been to a psychiatric hospital but I went there voluntarily, I've never been sure of the process for involuntary patients. After reading your hub I know a little more about the process. Great information, thank you.

endrun 7 months ago

It is entirely disingenous to proclaim that which is contained in the summary below. That is, that somehow the law protects folks from being locked up unfairly. It clearly does not and here is why:

Folks are locked up by the MI system under state law. Those laws are entirely vague as to what constitutes a danger to self or others, and as a result, the comment that Denise has never seen a Psychiatrist not follow the law is virtually meaningless. A Psychiatrist--or in fact ANY mental health professional, ie, person employed in the MI industry--can just proclaim it. It is VERY easily done. Once you are in there you have no practical right to a writ of habeus corpus, and therefore procedurally your legal rights are stripped more than from one accused of committing serial murder. That's number one. Number two is that no person in that environment is EVER given any procedural civil right such as the right accused criminals have to examine the evidence against him or her or cross examine witnesses. So the very simple and basic fact is there are ZERO procedural protections once locked up--including ZERO procedural protections PRIOR TO BEING LOCKED UP.

And so WHY would anyone consider that there are so many groups who are against these practices and thus loosely labelled "anti-Psychiatry"? Because of the very situation I just mentioned. And the fact that in the healthcare industry, you have an overwhelmingly powerful industry to go up against to effect change of any kind at all. For example, the healthcare industry dictated just what it would and wouldn't accept under the Affordable Care Act, and the President just went with what he was told would be allowed by the industry. That's what we have. Now let's examine the vagueness of these state laws to see what the legal issues are:1)any area of law can examine, usually, any law passed by any state and through test cases, try to have the federal courts or the high courts in the state firstly, declare such a law "void for vagueness." In other words, the prospective violator of any law has to have, by the wording of the statute itself, adequate warning as to just what behavior is considered breaking that law--else that law can be voided for the reason it is simply too vague to deliver such a warning. In fact this is the very fact of the matter with these MI industry involuntary commitment laws--yet no one has successfully challenged such laws using such a principle(YET). Now at the federal level, there are many cases which underscore the limits on involuntary commitment processes and also forced drugging, and yet since there are no procedural protections for "patients"(ie, "victims") during the commitment process and release process or judicial review process, this has to be done in each and every case after the fact. The only legal basis upon which to successfully challenge these sham committments is the basis of false arrest and kidnapping. The industry is not letting up as more and more families are being victimized by the lust of the MI industry because of economic incentives to do so--the case of Justina Pelletier who was kidnapped by the system in Massachussetts from her home in Connecticut is a perfect example of this. This phenomenon of "medical kidnap" is in fact not entirely new but certainly has picked up in recent years because grants to these Psychiatric hospitals and hospitals which have such wards has in fact also provided an added incentive to do to people what was done to Ms. Pelletier. So the simple fact is the industry is entirely out of control and the placement of preferential euphemistic language on these processes, places, and thugs involved do not render them any less evil or thug-like. Period.

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In Summary

It is important that we all protect and care for our own mental health. When it comes to loved ones, particularly the vulnerable, we must be vigilant about discerning when they may be struggling with real mental health issues, or simply living in a manner we do not understand.

The law protects our independence and self-determination. Imagine how grateful you would be for these laws if you felt you were being unfairly committed to a psychiatric hospital!

I hope you have found this article helpful as you investigate the facts about the commitment process.